GOVERNMENT OF ANDHRA PRADESH MODEL FORM - N Application for quarry prospecting Licence for Granite To be submitted in triplicate (See

Sub (5) of Rule 12) Dated ................Day ...........of...............20

Received AT ON Initial of the Receiving Officer

Latest Passport Size Photo of the applicant attested by a Gazetted Officer be affixed

To Through Sir, 1. 2. We request that a Prospecting License under APMMC Rules ,1966 be granted to me/us A Sum of Rs. 5000/- and DD for rs _____________ being the fee in respect of this application and deposit respectively has been Vide Challan No. dt. Of the State Bank of India /Treasury )DD No. dt. Of _______________________[ any Nationalized Bank ] The required particulars are given below :i. ii. iii. Name of the applicant with complete address . Is the applicant a private individual /private company /public company /firm or association In case applicant is : a) an individual ,his nationality . b) A company ,an attested copy of the certificate of registration of the company shall be enclosed c) A firm or association ,the nationality of all the partners of the firm or members of the association. Profession or nature of business of applicant. [ V -a] No. and date of the Valid clearance certificate of payment of mining dues (Copy attested )



(V-b) if on the date of application, the application does not hold a prospecting License ,it should be specified whether an affidavit to this effect has been furnished to the satisfaction of the State Govern ment vi. vii viii ix Details of the Granite which the applicant intends to prospect . Period for which the prospecting Licence is required . Extent of the area the applicant wants to prospect. Details of the area in respect of which prospecting Licence is required.




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(x) (a)Does the applicant have surface rights over the area for which he requires a prospecting licence ? If so with relevant certified documents. (b If not, has he Obtained the consent of the owner ,and the occupier of the land for undertaking prospecting operations] If so the consent of the owner and the occupier obtained in writing be filed. (in certified copies) N.B.:- The areas shall cover whole or recognized part survey numbers. (c) In case of forest areas ,the name of the working circle ,the range and felling series. (d) For areas where no forest or cadastral maps are available , a sketch plan should be submitted on scale showing the area applied for together with boundary ,if any ,of any other existing quarring lease or prospecting licence of the existing prospecting licence or quarrying lease areas (xi) The area applied for should be marked on plans as detailed below:a) In case cadastral map of the area is available the area on this map should be marked on the map showing the range and felling series N.B.:- The area applied for shall cover whole survey numbers. b) In case cadastral map of the area is available the area on this map showing the range and felling series . c) In case neither cadastral nor forest maps ,are available ,the area should be marked on a sketch plan drawn to scale showing on this plan all important surface and natural features , and dimensions of the lines forming the boundry of the area and the bearing and distance of all corner points from any important ,prominent and fixed point or points]

(xii) Particulars of the areas mineral --wise [ in each State duly supported by an affidavit ] for which the applicant or nay person joint in interest with him . a) Already holds under prospecting licence. b) Has already applied for but not granted ,or c) Being applied for simultaneously . (xiii) Nature of joint in interest , if any . (xiv) If the applicant intends to supervise the work ,his previous experience of prospecting and mining should be explained ,if he intends to appoint a manager, the name of such manager ,his qualifica tions, nature and extent of his previous experience should be specified and his consent letter be attached. (xv) Financial resources of the applicant. (xvi) Particulars of receipted treasury Challan and deposits attached for the amount referred to at 2 above. (xvii) Any other particulars or sketch map which the applicant wishes to furnish. I/We do hereby declare that the particulars furnished above are correct and am / are ready to furnish any other details including accurate plans as may be required by you. Place : Date : Yours faithfully

Signature and Designation of the applicant